Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention

Abstract

Purpose of review We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. Recent findings The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. Summary Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.

Heart valve surgery and the obesity paradox: A systematic review

“…58,59 Furthermore, a new era has begun in the field of cardiac surgery with minimally invasive and transcatheter procedures. 60,61 Although there is a great deal of literature regarding the obesity paradox in TAVR, there is limited research regarding transcatheter MV procedures with only three published manuscripts studying the impact of BMI on MitraClip being identified in the literature at the time of writing. [47][48][49] In this review, we identified a trend in which patients with over-…”

Sex-Related Differences in Transcatheter Mitral Valve Repair: A Systematic Review and Meta-Analysis

“…While significant differences exist in the outcomes between males and females undergoing MV surgery, the transcatheter MV intervention literature is relatively new and requires further investigation to elucidate the true relationship between sex and outcomes after transcatheter MV interventions. Furthermore, surgical and transcatheter MV interventions are utilized in treating differing valve pathologies with surgical MV interventions used to treat primary MR and transcatheter interventions used to treat secondary MR. With significant innovation occurring in the field of transcatheter MV interventions, investigating the impact of sex with future transcatheter MV repair and replacement devices is imperative [35]. Additionally, care should be taken in future trials to avoid the biases previously mentioned, such as underrepresentation of women in clinical trials, matching for severity of disease and repair technique.…”

Mortality and morbidity of surgical and transcatheter mitral valve repair in octogenarians: A systematic review

“…Compared to surgical mitral valve repair (SMVr), TMVr has been preferred in octogenarians since 2012 due to superior short‐term postoperative outcomes 20–22 . Of all the TMVr options, Mitraclip (Abbott Laboratories) is the most widely adopted device, which uses an edge‐to‐edge leaflet repair 23 . Octogenarians have often been underrepresented in cardiac surgery and cardiology literature despite the recent increase in this population undergoing mitral valve surgery.…”

“…[20][21][22] Of all the TMVr options, Mitraclip (Abbott Laboratories) is the most widely adopted device, which uses an edge-to-edge leaflet repair. 23 Octogenarians have often been underrepresented in cardiac surgery and cardiology literature despite the recent increase in this population undergoing mitral valve surgery. Herein, a systematic approach was utilized to review the literature investigating the morbidity and mortality of octogenarians undergoing MVr.…”

“…Focusing on larger populations and longer follow-up times, long-term outcomes can be better understood over a more diverse group of patients. Additionally, all articles included in this review used the Mitraclip for TMVr; however, there are several transcatheter devices in current development that were not included 23. Further research is warranted to determine if such new devices are able to effectively treat different MR etiologies in the octogenarian population and if these new devices result in comparable outcomes to SMVr options.…”